The practice of percutaneous surgery has long been aided by the use of retractors, retainers, tensioners, tenacula, spreaders and stabilizers. While the details of their constructions vary, all hold various tissues together or apart, these tissues neighboring the surgical wound, and ease the surgeon's access to the specific tissues of interest at the surgical site. Significant drawbacks in the use of conventional retractors and the like include the need for one or more surgical assistants to operate the devices, and the considerable time needed for the surgeon to direct the assistants in the precise positioning of the devices; other problems exist as well.
Some but not all of these problems are addressed by the type of retractor disclosed in U.S. Pat. No. 4,274,398 (Scott, Jr., Jun. 23, 1981) and U.S. Pat. No. 4,430,991 (Darnell, Feb. 14, 1984). That type of device includes a rigid stainless steel frame which is conformed to fit the surface contour of the portion of the patient's body to be operated on, fully surrounding the surgical site. The device also includes at least one stay, the stay having an elastic member and tissue holding means, for example, a hook. The frame has a plurality of notches in which the elastic member of the stay is frictionally held, to retract tissue held by the tissue holding means. The device is asserted to be advantageous in eliminating the need for one or more surgical assistants who would otherwise be needed to retract the tissues.
While useful for its intended purpose, the key to the utility of that type of device--its large, rigid frame--prevents its use in laparoscopic and other endoscopic surgical procedures. Further, the drawbacks of the other conventional retractors mentioned above become even more acute in laparoscopic surgery. Laparoscopic surgical procedures are performed at a surgical site within an enclosed body space. In order to reduce pain to the patient, to speed the surgery itself and to speed the patient's recovery, access to the enclosed space is available through only a limited number of cannulae puncturing the skin and tissue overlying the surgical site. Because access to the space is intentionally limited, adequate retraction or engagement of tissues neighboring the surgical site can be problematic.
Despite these problems, retractors are still necessary and useful in laparoscopic and other endoscopic procedures. One type of retractor is elongated and includes a proximal handle portion (positioned outside the patient's body during use) and a distal tissue-engaging portion (positioned inside the body space during use). The tissue-engaging portion can be shaped, for example, as an atraumatic hook, a spreading fan or a relatively broad, curved blade. Another type of device is simply a pair of blunt tipped subcutaneous forceps, long enough to grasp and manipulate the tissues in the body space.
Several problems have been encountered in the use of such retractors, however. They necessarily extend through the patient's skin and tissues to the surgical site, and therefore require a puncture site and access port for their own individual and exclusive use. Their use thus causes additional discomfort to the patient for each retractor used. Moreover, the prior laparoscopic retractors often extend across the surgical site, interfering with the surgeon's ability to see the site and its neighboring tissues. Obstruction of the surgeon's view compounds the problems inherent in performing a surgical procedure in a closed space. While retraction of tissues neighboring the surgical site has also been performed by the use of long sutures (passed through the skin and tissues overlying the site, around the tissue to be engaged, and back through the overlying tissues and skin), such a procedure is time consuming and increases patient discomfort, and is generally not an adequate solution to the problems of retraction.